The inverse relationships between socioeconomic status (SES) and unhealthy behaviors such as tobacco use, physical inactivity, and poor nutrition have been well demonstrated empirically but encompass diverse underlying causal mechanisms. These mechanisms have special theoretical importance because disparities in health behaviors, unlike disparities in many other components of health, involve something more than the ability to use income to purchase good health. Based on a review of broad literatures in sociology, economics, and public health, we classify explanations of higher smoking, lower exercise, poorer diet, and excess weight among low-SES persons into nine broad groups that specify related but conceptually distinct mechanisms. The lack of clear support for any one explanation suggests that the literature on SES disparities in health and health behaviors can do more to design studies that better test for the importance of the varied mechanisms.

Sleep duration is associated with cardiovascular disease and diabetes risk factors, depression, automobile and workplace accidents, and prospective mortality. Little is known, however, about sleep patterns in the US population. The 2004-2007 National Health Interview Survey-Sample Adult Files provide nationally representative data for 110,441 noninstitutionalized US adults aged 18 years or older, and multinomial logistic regression examines whether variables in 5 domains-demographic, family structure, socioeconomic, health behavior, and health status-are associated with long or short sleep duration. Being older, non-Hispanic black, or a current or former smoker; having low levels of education, income, or few income sources; consuming few or numerous drinks in a week; or reporting cardiovascular disease, diabetes, depression, underweight, or activity limitations is associated with increased odds of both long and short sleep duration. Other variables are associated with shorter (e.g., living with young children, being unmarried, working long hours, more frequent binge drinking) or longer (e.g., being younger, Mexican American, pregnant, or having low levels of physical activity) sleep hours. The authors identify numerous risk factors for long and short sleep; many of those variables are potential confounders of the relation between sleep hours and other health outcomes.

Jail and prison inmates had a higher burden of most chronic medical conditions than the general population even with adjustment for important sociodemographic differences and alcohol consumption.

Objectives-We investigated whether there were gender differences in chronic medical, psychiatric, and substance-dependence disorders among jail inmates and whether substance dependence mediated any gender differences found.Methods-We analyzed data from a nationally representative survey of 6982 US jail inmates. Weighted estimates of disease prevalence were calculated by gender for chronic medical disorders (cancer, hypertension, diabetes, arthritis, asthma, hepatitis, and cirrhosis), psychiatric disorders (depressive, bipolar, psychotic, posttraumatic stress, anxiety, and personality), and substancedependence disorders. We conducted logistic regression to examine the relationship between gender and these disorders.Results-Compared with men, women had a significantly higher prevalence of all medical and psychiatric conditions (P≤.01 for each) and drug dependence (P<.001), but women had a lower prevalence of alcohol dependence (P<.001). Gender differences persisted after adjustment for sociodemographic factors and substance dependence.Conclusions-Women in jail had a higher burden of chronic medical disorders, psychiatric disorders, and drug dependence than men, including conditions found more commonly in men in the general population. Thus, there is a need for targeted attention to the chronic medical, Correspondence should be sent to Ingrid A. Binswanger, MD, MPH, University of Colorado Denver School of Medicine, Division of General Internal Medicine, Mailstop B180, 12631 East 17th Ave., Aurora, CO 80045 (ingrid.binswanger@ucdenver.edu). Reprints can be ordered at http://www.ajph.org by clicking the "Reprints/Eprints" link. Contributors I.A. Binswanger, J.O. Merrill, J. G. Elmore, and M.C. White conceptualized and designed the study. I. A. Binswanger acquired, analyzed, and interpreted the data, supervised the study, and drafted the article. P.M. Krueger assisted with data analysis. J.O. Merrill, P.M. Krueger, M. C. White, R. E. Booth, and J. G. Elmore critically reviewed several drafts of the article.Note. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the US Department of Veterans Affairs, the Robert Wood Johnson Foundation, or the University of Colorado Denver. The funding sources had no role in the design and conduct of the study or analysis and interpretation of the data and did not participate in the decision to submit this manuscript for publication or in the preparation of the manuscript. Human Participant ProtectionData were obtained from secondary sources. The protocol for data analysis was approved by the Colorado Multiple institutional review board and was considered exempt by the institutional review boards of the University of Washington, Seattle; the University of California, San Francisco; and the University of Texas Health Science Center at Houston. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript psychiatric, and drug-treatment needs of women at risk for incarceration, both ...

Studies of individual countries suggest that socioeconomic status (SES) and weight are positively associated in lower-income countries but negatively associated in higher-income countries. However, this reversal in the direction of the SES-weight relationship and arguments about the underlying causes of the reversal need to be tested with comparable data for a large and diverse set of nations. This study systematically tests the reversal hypothesis using individual- and aggregate-level data for 67 nations representing all regions of the world. In support of the hypothesis, we find not only that the body mass index, being overweight, and being obese rise with national product but also that the associations of SES with these outcomes shift from positive to negative. These findings fit arguments about how health-related, SES-based resources, costs, and values differ across levels of economic development. Although economic and social development can improve health, it can also lead to increasing obesity and widening SES disparities in obesity.

PURPOSE American television viewers see as many as 16 hours of prescription drug advertisements (ads) each year, yet no research has examined how television ads attempt to infl uence consumers. This information is important, because ads may not meet their educational potential, possibly prompting consumers to request prescriptions that are clinically inappropriate or more expensive than equally effective alternatives. METHODSWe coded ads shown during evening news and prime time hours for factual claims they make about the target condition, how they attempt to appeal to consumers, and how they portray the medication and lifestyle behaviors in the lives of ad characters.RESULTS Most ads (82%) made some factual claims and made rational arguments (86%) for product use, but few described condition causes (26%), risk factors (26%), or prevalence (25%). Emotional appeals were almost universal (95%). No ads mentioned lifestyle change as an alternative to products, though some (19%) portrayed it as an adjunct to medication. Some ads (18%) portrayed lifestyle changes as insuffi cient for controlling a condition. The ads often framed medication use in terms of losing (58%) and regaining control (85%) over some aspect of life and as engendering social approval (78%). Products were frequently (58%) portrayed as a medical breakthrough.CONCLUSIONS Despite claims that ads serve an educational purpose, they provide limited information about the causes of a disease or who may be at risk; they show characters that have lost control over their social, emotional, or physical lives without the medication; and they minimize the value of health promotion through lifestyle changes. The ads have limited educational value and may oversell the benefi ts of drugs in ways that might confl ict with promoting population health.

Objective This paper addresses the relationship between suicide mortality and family structure and socioeconomic status for U.S. adult men and women. Methods We use Cox proportional hazard models and individual level, prospective data from the National Health Interview Survey Linked Mortality File (1986–2002) to examine adult suicide mortality. Results Larger families and employment are associated with lower risks of suicide for both men and women. Low levels of education or being divorced or separated, widowed, or never married are associated with increased risks of suicide among men, but not among women. Conclusions We find important sex differences in the relationship between suicide mortality and marital status and education. Future suicide research should use both aggregate and individual level data and recognize important sex differences in the relationship between risk factors and suicide mortality—a central cause of preventable death in the United States.

The combination of high stress levels and high levels of former smoking or physical inactivity is especially harmful among low-SES individuals. Stress, unhealthy behaviors, and low SES independently increase risk of death, and they combine to create a truly disadvantaged segment of the population.